Epstein

At my best, I see psychotherapy in the same light. Many people who come to therapy are disgusted with themselves for one reason or another, much as the Buddha was in his own time and in his own way. This disgust can take many forms: shame, fear, anxiety, or feelings of unworthiness are common expressions of it, but the possibilities are endless. Some people even develop what is called a “reaction formation” and seem the opposite of disgusted. They come across as prideful or conceited and unwilling to admit their faults or self-doubts. But these individuals are often just propping themselves up, creating a false front to mask their vulnerabilities, and somewhere inside they are troubled because they know they are not being real.

No one—guru or roshi or priest—can program for long what a person might think or feel in private reflection. We learn we cannot in any literal sense control our mind. Meditation cannot serve an ideology. A meditation teacher can only help a student understand the phenomena that rise from his or her own inner world—after the fact—and give tips on directions to go. . . . Within a traditional Buddhist framework of ethical values and psychological insight, the mind essentially reveals itself.” - Gary Snyder

He was talking about the mind revealing itself, about the vivid and transparent thing

hidden within the twisted shards of our individual personalities. Did I see that freedom in my patients?

While it took Ram Dass to express it for me, I recognized the truth in what he was saying. I do see my patients as already free. The seed is in them already, just as the Buddha’s joy under the rose-apple tree was there within him. My challenge in being a therapist has been to stay true to this vision even when my patients, like my mother, object.

As Ram Dass liked to say in his later years, “We are all walking each other home.

The placebo effect points to the body’s capacity to heal itself, helped along by some combination of trust, faith, and human empathy. Meditation seemed to be promising something similar for the mind. Given the right conditions, the mind could realize its own potential, healing itself through a combination of self-awareness, mindfulness, insight, and compassion. In turning meditation into a standardized medical treatment, something was

being sacrificed, akin to what is lost when one’s kindly country doctor is replaced by a harried technician or a robot.

... but I knew I was searching for an approach more grounded in the traditions long associated with it, not one that was wholly divorced from them. As much as I appreciated the burgeoning science of meditation, I was also in search of its art. I completed my report on the placebo effect, praising it for what it implied about the mystery of healing, submitted my paper for publication, and returned to my studies. It was another year before I meditated again.

From the point of view of Highest Yoga Tantra, difficult emotions do not need to be suppressed or eliminated, as some more elementary meditations strive to do. Their energies can, instead, be used for enlightenment. By moving the attention from a complete immersion in the feeling to the observation of it, the emotions could be harnessed for spiritual purposes. The mind is a terrible master but a wonderful servant, this approach proclaimed. Evocative paintings of wrathful or erotic deities adorning the Tibetan temple walls made this point with graphic emphasis. Anger, no longer an obstacle to meditative attainment, was portrayed in these paintings as an instrument of insight. Desire, no longer viewed as an obstructive impediment, was embodied as a vehicle of empathy. Ambition, no longer for personal aggrandizement, was represented as the intention to help others. As if to highlight the connection between the personal and the spiritual, the four esoteric stages of Highest Yoga Tantra were named for four stages of falling in love. Looking, smiling, embracing, and orgasm are the closest one comes in regular life to the joyous celebration, and spontaneous loss of ego, uncovered in successful meditations of this type.

He used the analogy of someone wearing sunglasses to illustrate his point. The sunglass wearer does not mistake the distorted color for reality even though things appear rosier when seen through their lenses. We are like a person wearing sunglasses who has forgotten they are on, taking what we see for granted rather than understanding that we are laying a scrim over it. The self exists, but not in the way we ordinarily take for granted, he seemed to be saying. We have to put it to good use rather than trying to shore it up or, alternatively, tear it down.

For me, meditation had come to mean being with my own mind no matter what state it was in. In this way, it was closer to psychotherapy than I had initially thought.

Just as he had not urged me to jettison my sense of self, he was neither encouraging an empty mind nor recommending meditation simply as a form of rest and repose. He was asking us to use meditation to look into our minds and examine our behavior, to listen to the way we spoke to ourselves and thought about others, and to explore the attitudes we held in our most personal and private thoughts. From his perspective, inner peace is possible only when one has made peace with one’s own mind, when one’s own inner violence has been dealt with. This requires honesty and an internal ethic that is endlessly challenging. Inner peace comes not from turning off the mind, but from deliberately confronting one’s own innermost prejudices, expectations, habits, and inclinations.

In learning to meditate, albeit from some of the best teachers I could find, I came to appreciate that once I understood the basics, I had to teach myself how to do it. I had to take what I had learned, in terms of the formal techniques, and then make it real from the inside. Only then could I begin to appreciate what meditation could and could not accomplish.

But the mindset of the West threatens to reduce our ability to truly benefit from this integration. We want a quick fix with demonstrable results. We want to see changes in our

brains. We want the experts to show us what to do and even, if we are lucky, to do it for us. In its absorption by the wellness movement, meditation threatens to become more like cosmetic dermatology than the ongoing self-examination that is its own kind of higher education.

Vipassana illuminated this for me, connecting me to my history in a deep and meaningful way, while pointing out the randomness of the material that formed me. The self is constructed on a very insecure foundation. We emerge from nothingness and cobble ourselves together out of the arbitrary and unbidden experiences that come our way. My wife, describing the simultaneous horror and wonder of pregnancy, likes to say that she made a baby out of tuna fish. What could be more strange than growing a human being inside one’s body? Meditation lets us see something similar. It shows us how we are continually constructing a self out of the raw material of our everyday experience. Like the blind man and the elephant in the Indian parable, we grope in the darkness, telling ourselves a story out of whatever bits and pieces we manage to touch.

Seasoned meditation involves the interplay of concentration and mindfulness; both are cultivated from the start. It is very difficult to stay mindfully attentive to rapidly changing elements of experience, for instance, without the buildup of sufficient concentration, so most meditators in the Buddhist traditions are using both techniques at different times, oscillating between the two modes of attention.

One of the first things I discovered was that there was really no playbook for how to be a therapist. As with meditation, it had to be figured out from the inside. There was no script to

follow when sitting with a patient, no “right way” to handle things, only a set of ethical guidelines and a trust that listening “with a third ear” would help shape a useful response and serve a useful purpose. Each person, each visit, and each issue required an improvisatory spirit that kept me on my toes, much as I had felt when practicing mindfulness on my first silent retreats. I have had wonderful teachers, supervisors, and therapists, but, even in my first days, while still in training, once the door closed and I was alone with my patient, no one knew what I might do or say, least of all myself.

Lawrence wrote the poem in conventional everyday language, describing a brief sighting of a golden snake while he was fetching water from his backyard well. But he had a poet’s self-awareness, similar (if not identical to) that which is cultivated in meditation. He observed not just the serpent but also his own mind.

And immediately I regretted it.

I thought how paltry, how vulgar, what a mean act!

I despised myself and the voices of my accursed human education. - D.H. Lawrence

For it is only by observing the ego dispassionately, over and over and over again, that its nature can be significantly revealed. Without direct experience of how limiting its small-mindedness can be, there is no motivation to grow beyond it.

In trying to bring a measure of understanding to their hectic lives, they have sought therapy, looking for meaning in the midst of time that speeds past, interrupting the breakneck pace of everyday life for a measure of pause and reflection.

A monk asked, “What is the substance of the true person?”

The Master said, “Spring, summer, autumn, winter.”

The monk said, “In that case, it is hard for me to

understand.”

The Master said, “You asked about the substance of the true

person,

didn’t you?” - Traditional Zen koan

But I have never felt that I was an expert in either tradition, nor have I been motivated to formulate, let alone trademark, a hybrid between the two. I reacted with horror at the advent of “mindful psychotherapy” and have always been careful neither to cloak myself in spiritual garb nor to dismiss the accumulated wisdom of contemporary psychoanalytic thought. Mindfulness as a substitute for traditional psychotherapy strikes me as shortsighted, throwing the baby out with the bathwater, and blending the two traditions, just as they are getting to know each other, has always seemed premature. Most such attempts have cobbled together superficial elements of each to the detriment of both.

I challenged myself over the course of a single year to write down, as accurately as I could recall, the details of at least one session every week (or every other week) when something interesting caught my eye, when I had the sense that the Buddhist element was in play. Sometimes this influence was overt: people might ask me about meditation technique, or I might spontaneously bring something I had learned from Buddhism into the conversation. And sometimes it was only a feeling: I might find myself reaching beyond traditional analysis to help someone grasp an alternative perspective on whatever issue was troubling them.

I made no effort to chart the progress of any particular patient but focused instead on my own feelings of having contributed something of value in whatever encounter I chose to record. In the course of this chronicle, therefore, many patients are introduced but make only a single appearance, while only a few reoccur. Rarely are any issues resolved or settled, but there are nonetheless often hints of movement, of growth, and of opening.

The mention of Kuan Yin was spontaneous; I did not know whether Jack was familiar with her, and, when he was not, I needed to explain her to him. This took some time and threatened to overwhelm the session, taking him away from his feelings and into his intellect. But I wanted to turn around Jack’s long-standing sentiments of never having been enough. If he could imagine himself, even for a moment, as the healer, I hoped this would begin to offset his unquestioning identity as someone who needed to be healed. His slightly off-balance reaction to our interchange suggested some degree of success. Instability is sometimes a sign of new possibilities.

We all cling in one way or another, but as Hakuin reminds us, if we are searching for freedom, we must learn to lift up our hands. Early trauma like Jack’s cannot be healed by simply pointing out its origins. Understanding that he was not the cause of his parents’ anguish will not relieve him of the burden of it. But by working diligently to offset his mind’s tendency to repeat itself, Jack can become compassionate toward his childhood predicament rather than identifying exclusively with the pain of it. This was the deeper message I was trying to convey.

Unsolvable trauma is unsolvable but it is not unresolvable.

In the next series of sessions, as my project got underway, this notion of finding the clinging was often paramount. What could I do to surprise, unsettle, and enliven my patients’ inner lives? While not necessarily religious, these interventions, when successful, could certainly feel spiritual.

Sexual abuse like the kind Willa experienced robs a person of innocence. Instead of discovering erotic life in a natural way with a peer, sexuality was forced upon her. Any pleasure she might have found in the awakening of her sensuality was contaminated from the beginning with confusion and shame.

We hypothesize that Ingrid turns separation into abandonment and then seeks connection through sadness. Mitch takes it personally when she does this and then gets angry and feels unappreciated. I want Mitch not to take it personally but to be clear with Ingrid that although she cannot fix Ingrid’s sadness, she can bring her joy nonetheless.

How will Ingrid ever begin to take responsibility for her abandonment fears if her partner meets them with such legalistic zeal?

It’s not what she is thinking that matters, it’s how she relates to her thoughts that will make all the difference.

Each time I heard it, it seemed so profound! There is so much in life that we cannot control no matter how we try. Circumstances, events, feelings, even our own thoughts! But we can take responsibility for how we relate to what happens. We can grimace with our hands over our ears or we can lift one hand. By now, this has become a refrain in my mind, one that often returns to guide me in my life and in my work with patients.

I show her my favorite Buddhist book about tantric sex, Passionate Enlightenment by Miranda Shaw, in which female arousal is described as the most sublime, the closest one comes in regular life to the bliss promised by the Buddha’s enlightenment.

In the esoteric Buddhist literature, female sexuality is said to embody one’s highest spiritual intelligence. In its fullest form, it represents being rather than doing. Violette’s desire to please and her perfectionism worked against her being.

Winnicott, my psychoanalytic hero, had something to say about this kind of situation. He was writing about parents’ concerns about children’s lies, but his insights go well beyond lying.

If development proceeds well the individual becomes able to

deceive, to lie, to compromise, to accept conflict as a fact and to

abandon the extreme ideas of perfection and an opposite to

perfection that make existence intolerable. Capacity for compromise

is not a characteristic of the insane. The mature human being is

neither so nice nor so nasty as the immature. The water in the glass

is muddy, but is not mud.

Rachel’s boyfriend could not believe that he was enough for her, that she actually was satisfied by him and with him. He needed her reassurance and he needed her to faithfully pick up the phone when he called. In my formulation, he was endeavoring to stave off debilitating feelings of inferiority that surfaced immediately when she was unavailable, feeding the need to cling to her all the more tightly. Right away, as if regressed to a childhood place, he imagined her with another lover. Rachel’s spontaneous cry, “What are you, twelve years old?” was off, in my view, by six or seven years.

We all carry our early relationships inside of us; psychoanalysis made hay out of this fact in its concept of transference. When we are fortunate enough to find someone to love, these early relationships, hidden in our unconscious, are unlocked. When they are understood as reflections of the past, the energy they contain can infuse and enrich one’s current relationships. When taken as present-day fact instead of archaic fantasy, though, they can be incredibly destructive, the horse carrying the rider far from where he really wants to go.

If I had gathered anything from studying mindfulness, it was this: don’t push away the unpleasant and don’t cling to the pleasant, but give impartial attention to everything there is to observe.

Learn how to give loving attention to your whole experience. Open yourself, even to those aspects you would rather do away with. Cultivate equanimity rather than searching for the next peak experience.

We must arrange our music, we must arrange our Art, we must arrange everything, I believe, so that people realize that they themselves are doing it, and not that something is being done to them.” - John Cage

I tell Fred how simple meditation can be. “You really don’t need the apps. Meditation is doing nothing. Just sit there and watch your mind. It’s purposeless,” I say. “As soon as someone tells you how to do it, you will have expectations for what is supposed to happen. Meditation is about opening a window into yourself with no expectations of what you will find. That’s how it can be surprising. You just sit there. Try not to complicate it.

With the recent popularity of mindfulness and the proliferation of apps and blogs and podcasts about it, people like Fred tend to look to it as a kind of mental gymnastics, good for one’s health and beneficial if practiced on a regular basis. This is not necessarily mistaken, but it can make meditation feel like just another thing one is doing wrong. While some of my patients have been able to prioritize the regular sitting practice of mindfulness, many others, in the midst of busy work and family life, cannot.

What I liked about this conversation was talking about mindfulness as doing nothing. So many people get into trouble with it because of their desire to always be in control. The line between helpful discipline and rigidifying control is not always so clear, and when there is a tendency toward perfectionistic striving, meditation can be recruited into serving that master. I didn’t want Fred to fall into that trap. His superego did not need a boost from meditation.

In my world, we call these retroflections, when someone puts out an intention but then partially takes it back.

As Adam Phillips describes it, “In Winnicott’s view, the mind is that part of the self invented to cover for, to manage, any felt unreliability in the caregiving environment. It is, as it were, a necessary fiction, born of expedience, and therefore potentially tainted by (unconscious) resentment. Whenever the world is not good enough one has a mind instead.

That I was resorting to my own discursive thinking was an irony not lost on me. My advice to Beth, however well intentioned, was not able to conclusively penetrate the mental walls she had erected.

The worst thing would be that he feels your tension around it or your sadness at the loss and thinks that it’s because of something he did. Kids feel what’s going on around them but they can’t understand, and they make it be about them if you don’t help to explain it. Death is very hard for any of us to understand; it certainly will be difficult for him, but he will grow into it and you can help him over the years.

But in reading it over and over we learned one of the great lessons of mindfulness: trying to avoid that which makes us uncomfortable only makes us more tense, irritable, anxious, and afraid.

One of the things Buddhist psychology is best at is itemizing which emotional tendencies are the most ingrained. They are listed as the “ten fetters,” and this tendency to measure oneself is said to be one of the most subtle and difficult to uproot. Even lust and anger are easier to deal with than conceit.

I am reminded of the four qualities of the Zen Buddhist aesthetic (simplicity, naturalness, directness, and profundity) and the four dominant moods of Zen poetry (isolation, poverty, impermanence, and mystery).

Could he echo, at the close of his week’s vacation, the eighteenth-century Zen poet Bakusui’s haiku in which he wrote sparingly but utterly succinctly of the surprise of coming home to himself one fine spring day?

Returning

by an unused path—

violets.

I think I came closer in this session than in many of the previous ones to encouraging the kind of shift I am after for my patients. It did not come through my explanation of the concept of conceit but from the surprise of suggesting that Zach simply be a friend to his friend. The element of surprise was important. Startled by my comment, Zach had a glimpse of another way of relating. It made sense to him in the moment, not just conceptually but personally. The Zen poem connotes a similar feeling, returning by an unused path. Could that also be mindfulness, coming back via an intrinsic but unfamiliar resource to find the unexpected? But when I read the poem to Zach at a later date, instead of hearing “violets,” he heard the final word as “violence.” A Freudian slip, we might conclude.

Finally, somewhere in my late thirties, I had an epiphany. It dawned on me that all the questions about being a doctor were just my father’s way of trying to make contact. He didn’t know any other way. When I stopped resenting his questions and judging him for them and just answered, without truculence, things got much better between us. We could actually talk! I thought this might be helpful for Sarah to hear. We can benefit from meeting our parents where they are, instead of resenting them for where they are not.

Buddhist thought has been helpful for me with this because the Buddha’s first noble truth—that life is tinged with a sense of pervasive unsatisfactoriness (or suffering)—takes it as a given that there is always some way that we feel unseen, unknown, or unrecognized.

Psychoanalysis has explored many of the most obvious parental failings that contribute to such feelings but, in trying to find the source, or the cause, of personal uncertainty, it has encouraged people to overly blame their families of origin rather than taking on the responsibility of reaching out to establish whatever kinds of connections are actually possible in life.

The true target, of course, from a Buddhist perspective at least, is the overly inflated sense of self that is nourished by one’s personal grievances. Once one identifies that target, it becomes possible to free oneself from an exclusive identification with it. In that direction lies freedom.

Loyalty to her mother has made Rebecca distance herself from her need for her father. Her sadness has become a secret even to herself.

Mindfulness has proven very useful for people who tend to act out their feelings rather than experience them internally by encouraging them to reflect rather than react, but therapists like Marsha Linehan, the founder of dialectical behavioral therapy, have discovered that these very people, who seem so “emotional,” actually have very little idea what they are feeling. Linehan, a behaviorist, had the insight that such people are actually phobic toward their own emotions, that when they get an inkling of a disturbing feeling, they go into a kind of panic and, in running away from the experience, express it, or act it out, rather than experience it.

Staying with the feeling is key,” I declare. “Most people go straight to what is wrong with them rather than staying with the feeling.” David’s eyes fill with tears. I can see that he is following my logic. “I’d like to believe it,” he says quietly.

I was pleased with this session because I managed to get David to feel behind all of his accrued self-doubt and into his heart. For an instant, when his tears began to flow, I knew he was connecting to a neglected but super-important part of himself. We had gotten to this place through a discussion of mindfulness, but our conversation did not stop at the intellectual level. David’s memory had led us deeper into his personal history and straight to the defenses he had built around his mother’s unavailability. By allowing himself to follow his affect rather than dwelling in his story, David was able to discover something true: the love he had always doubted was alive inside him.

The division between meditation and real life is artificial. Doing each thing with full attention turns everything into a meditation.

Rage against the self is an attempt to solve a frustrating problem. It protects loved ones who are not only loved but also hated. Therapists who work within this paradigm look to the transference relationship to help a person heal. Encouraging a patient to articulate angry feelings toward the therapist is often a useful way of unpacking some of that stored energy that has heretofore only been able to express itself against the self. From this perspective, it is an achievement to be ambivalent, to hate those who are also loved without turning the hatred back on oneself.

The Buddha’s teachings run counter to this tendency to find fault. He normalized feelings of inadequacy and threw responsibility back onto the individual to sort them out. He taught mindfulness as a method of probing the self and found that impartial attention to moment-to-moment experience yields surprising but predictable insights into the self’s

contingent and relational nature. These insights, which precipitate spontaneously out of concentrated attention and mindful reflection, make abundantly clear that our habitual efforts to defend ourselves against our intrinsic groundlessness make things even worse.

Even with good-enough upbringing and the consolidation of what might be called a good-enough self, according to the Buddha’s logic, there will still be disquiet, confusion, and insecurity because we are all instinctively struggling to be something (independent, solid, coherent, and self-sufficient) we can never be. Even in healthy personality development, we emerge from childhood defending against the underlying truth of how contingent, provisional, and dependent we actually are. The persistence of such feelings, far from being a symptom of parental failures (even if there have been such failures), is actually the seed of wisdom. Fighting against them only rigidifies our defenses and isolates us further. Acknowledging the emptiness that frightens us, whatever its source may be, is the key to a deeper, and truer, understanding. The emptiness that we fear is not really empty. When it is successfully turned

into an object of awareness, it reveals itself to be vast, luminous, and reassuringly, albeit mysteriously, alive.

That evening, I had dinner with my former therapist and current friend, Michael Vincent Miller. I told him about the two sessions, about how it can take so many years for certain things to come out. I have enormous respect for Michael’s therapeutic acumen. He helped me a lot as my therapist and has guided me for years while becoming a real friend, and I have referred many patients to him. In the past fifteen years, he has begun to meditate, and we now share an interest in how seamlessly the two disciplines of Buddhism and psychotherapy can fit together. “You know what makes Buddhism and therapy similar?” he asked me. I waited for him to tell me. “They both aim for the restoration of innocence after experience.

We are educated to think that experience is what matters, that we must learn from experience, that experience is what makes us mature. But I want my patients not to be weighed down by their experience. Can they be open to what happened to them without feeling that they are somehow to blame? Can they own their attractiveness, their beauty, and their erotic potential without being perpetually tarnished by early abusive encounters? In one way or another, we are all broken by experience and could easily spend our lives trying to come to terms with it. But there is something more important for us to do, and Michael had his finger on the pulse of it. The restoration of innocence after experience. I realized some time after our dinner that he had been pointing at the moon.

Reflecting on this session, I am reminded once again of the concept of the mind object, both Beth’s and my own. By focusing too much on the particulars of Beth’s food issues and trying too hard to make a change in her behavior, I was getting drawn back in to her closed world instead of helping her break out of it. I had lost track of Michael Vincent Miller’s essential point and was therefore, not surprisingly, sacrificing innocence for experience.

I have such a hard time relaxing,” she says. “With men especially, and if I’m attracted to them it’s worse.” There is a longing in April to be known, to be reached, and to be seen, but she is frightened of it at the same time and cannot help but throw up obstacles seemingly in spite of herself. She might spill something in such a situation, for instance. When immersed in her work, April is the opposite. She can be funny, irreverent, spontaneous, innovative, and free. We talk about the paradox. When she loses herself, she is being herself.

In some way, this is what I want to convey to April. We all wish we could just eliminate the dysfunctional parts of us. In pushing against what we do not like in ourselves, we get more knotted up. The shame, discomfort, embarrassment, and pain just reinforce the hold the whole thing has over us, and, in the process, we over-identify with an aspect of ourselves that does not need to define us so completely. Seeing this overidentification clearly is what I think of as insight.

But her self-criticism was learned. How she learned it, and who she learned it from, we do not know. Therapy could take a good deal of time trying to get answers to these questions, and the answers might be interesting and even potentially helpful, but it is much more important, I think, that April understand that she could learn to pull back from a complete identification with the self-critical voices in her head.

This is the ultimate Buddhist therapeutic maneuver. The trick is not to ignore the emotion but to leave it alone, allowing it to appear in its own way, appreciating it for what it seems to be without getting taken in by it.

In our culture, we often have trouble distinguishing selflessness from submission, but they are very different things. Lukas was inclined to keep his feelings bottled up, but this scenario could not go on forever. His feelings were coming out in spite of himself, and his marriage needed more contribution from his side if it was to thrive. I think Lukas wanted his husband to understand what he needed without having to articulate it. There is a risk involved in speaking up, the age-old risk of loss of love. I didn’t think Lukas gave himself enough credit in his relationship; I didn’t think he valued himself enough. I meant it when I told him it was up to him to educate his partner. Sex was one important theater for this kind of exchange; I doubted that it was the only one.

As a therapist, I have been taught to pay close attention to the intimate details of people’s lives in order to help them decipher the mystery of who and what they have become. But as a meditator, I have learned that experience isn’t everything. It can just as easily obscure one’s truth as reveal it. This is the paradox I have faced in bringing these two worlds together. Traditional therapy unpacks in order to make sense. Meditation asks us to stop making sense so that we can find where happiness truly abides. Therapy examines the accumulated self, the one that is shaped by all the defenses we have used to get through life. Meditation asks us to divest ourselves of those very defenses so that we can recapture the original and intrinsic vitality we were born with.

But, as important as it is to understand the sources and details of one’s pain, understanding is rarely enough. My patients come to therapy wanting the burden of their accumulated experience lifted. Yes, they want to make sense of their lives, but that is not usually their fundamental or exclusive aim. First and foremost, they are trying to get over their accumulated trauma in order to feel less fearful, isolated, forlorn, helpless, alone, anxious, or depressed. They might not be able to say it so clearly, but they are reaching for things

beyond thought, trying to make contact with essential capacities that have been sacrificed in their efforts to adapt, adjust, comply, cope, or conform.

The wiring for change is built in, but some sort of benevolent attention has to activate it. Winnicott called this the “facilitating environment” and linked it to a mother’s natural, and “good-enough,” devotion. He believed that aggression is intrinsic to a baby’s psyche, that it shows up as an aspect of an infant’s inherent self-centeredness, and that a good-enough parent coaxes a child—over time— from total demandingness into a recognition of the parent as a person in their own right.

In an intriguing book called Bring Me the Rhinoceros: And Other Zen Koans That Will Save Your Life, John Tarrant, a Western Zen teacher and psychotherapist, outlines seven qualities that explain how Zen Buddhism uses koans to achieve this kind of breakthrough. Koans are riddles for which there are no rational answers.

Tarrant paints a vivid picture of how challenging this can be. In one of my favorite

passages, he puts it like this:

If you are used to living in a small room and suddenly discover a wide meadow, you might feel unsafe. Everyone thinks that they want happiness, but they might not. They might rather keep their stories about who they are and about what is impossible. Happiness is not an add-on to what you already are; it requires you to become a different person from the one who set off seeking it.

Shirley is striving to be “indifferent,” in her words, to her exhusband’s complaints, but I know there is an alternative to indifference that is closer to equanimity with a dose of compassion. Of course her ex is enraged and of course she feels unfairly attacked but, from an emotional

perspective, he has a point. Just as a mother has to bear the hatred intrinsic to being a mother, Shirley will have to accept the consequences of her decision to divorce. Craving understanding from the person she has left is not going to get her anywhere.

Dr. Kernberg was kind to me and helped me to see that, while their deprivation may have been real, these patients had lots of internal conflict around anger that was holding them back. In showing me this, he also, without having to say it directly, made me see that I, too, was pushing anger away. He gave me language to use. “You might not be aware of how angry you are,” he suggested I say. “But you are in danger of destroying the very support you need the most.” By beginning my communication with “you might not be aware” rather than confronting my patients’ anger directly, I could encourage them to reflect upon something they were otherwise just acting out unawares. My skills as a therapist improved dramatically as a result. Kindness without the proper intelligence to back it up was of little use, but the use of kindness in the service of therapy’s insights was very helpful.

Rather than clearly seeing what was wrong, and laying the responsibility on her parents, she had remained vague, telegraphing her pain to those around her while simultaneously taking the burden upon herself. “You had to shut yourself off,” I tell her. “To protect yourself, but also to protect your parents. You loved your father,” I reminded her. “His behavior didn’t make sense. You took it on yourself instead.

In one of his most important papers, “The Development of the Capacity for Concern,” written in 1963, toward the end of his life, Winnicott explained how important it is to help patients explore the ways that anger has kept them under its spell. Concern for others, he made clear, depends on being able to see others as whole people in and of themselves rather than as being there only to serve one’s needs.

His mother was a compelling figure, the center of the household, who indulged Steve as long as he did not question her, but ignored him when he did. We might say she was there as an “object-mother” but erratic as an “environment-mother.” This created a big problem for him. There was no room for integrating his anger in this relationship, no possibility of Steve’s mom ever admitting a flaw, and no acknowledgment of Steve’s independent point of view. The natural give-and-take of a mother-child relationship, in which both parent and child get disappointed with one another but learn to tolerate, and forgive, on the road to becoming

interpenetrating centers never happened.

Steve, we began to see, was never given the chance to work productively with his own aggression. It was as if he had no guidance through the inevitable disappointments of early life.

”All we do in successful psychoanalysis is to unhitch developmental hold-ups, and to release developmental processes and the inherited tendencies of the individual patient. In a peculiar way we can actually alter the patient’s past, so that a patient whose maternal development was not good enough can change into a person who has had a good-enough facilitating environment, and whose personal growth has therefore been able to take place, though late.” - Winnicott

Jean is criticizing herself for doing something harmless while at the same time rebelling against doing the one thing she has to do to keep her medical license. She is proclaiming her innocence in regard to the opioid prescription but pleading guilty to watching too much TV. Things are all twisted, and I do my best to straighten them out. “There’s a big difference between turning off the TV because you are tired and turning it off because you are supposed to,” I say. Jean has every right to watch as much TV as she wants; it is her only pleasure these days, the only relief from the surveillance she is under. I continue to talk with her about changing the story she is telling herself, about treating this time as a retreat (with TV!) into which she can surrender. Surrender becomes a theme we can explore. Jean is a conscientious and experienced clinician. She is devoted to her patients, and she knows that clinical work is much more important, and meaningful, than the electronic medical records being demanded of her. But right now, for the next year and a half, the medical records have to have priority. Can she submit to that with patience? Can TV be her reward? Or will her sense of the injustice perpetrated upon her paralyze her even further?

Jean had no doubts about who she was. Not only was she wrong to have written the forbidden prescriptions, she couldn’t even focus on her medical records. Nothing was working out the way she hoped. The fan in her life was definitely broken. Were I to focus

only on what was broken, I would be pulled into her suffering instead of pointing the way out. I wanted more uncertainty for Jean, more of that Zen doubt. Whatever conclusion she aggressively threw at me, I parried it back at her until we reached a truce. Surrender was Jean’s rhinoceros. It went against everything she thought.

I try to talk to Violette about how this could be good, about how the concept of what is ideal might be getting in the way of what is true, and possibly good enough. In the back of my mind are earlier discussions we have had about how her desire to please might be getting in the way of her own enjoyment. “You are going deeper into your own space,” I suggest. “Your husband can get the runoff. That will be nourishing for him. He can appreciate you as other and you will feel affirmed.” Violette is not necessarily having it. “Still, it’s not ideal,” she replies. But then she reflects upon some earlier relationships with actors who had more embodied her sense of the ideal. She had tended to submerge herself in those relationships, privileging their talents over her own, and had ended up feeling used and unappreciated. “I might not be so happy in the ideal,” she admits. “This is real,” I repeat. “Grappling with the real is the way to go.

Violette had a wonderful feeling for the joy of connection and the benefits of generosity. She was a selfless person in many regards. But her upbringing had not made enough room for healthy aggression, and this had made it difficult for her to balance the inevitable give-and-take of separation and connection. Beneath her compliant exterior lay an aggression that made her feel guilty and removed from the people she loved. Surrender was not going to be Violette’s rhinoceros. She knew about surrender already. Her rhinoceros was much more likely to look like a rhinoceros.

Developmental trauma is trauma that occurs when we are children, from either bad things

happening or good-enough things not happening.

The emotional consequences are too intense for the child to bear and, to protect himself or herself, dissociation takes place in which the unbearable feelings are closed off and put aside so that the child can go forward safely. A kind of armor is created, but the unmanageable feelings lurk and rise up unbidden at inopportune times as if out of nowhere. Winnicott described such feelings as like being “infinitely dropped,” and eloquently wrote of how the afflicted person often fears a breakdown that has already happened. The person projects the thing from the past into the future because they were not able to be present with the breakdown when it was actually taking place. To be free, they have to be able to remember the trauma that was never fully experienced, and they have to be able to put it in its proper place in history.

She needed understanding, verbal and conceptual framing, before she could use meditation in any profitable way. “Now when I sit I mostly have a transparent feeling; I feel sort of porous,” she says. “Is this wrong?

Winnicott, and here the parallels to the Buddha are difficult to ignore, believed that “being” precedes “doing,” and that its recovery is the route back to our original nature. He felt that “being” is everyone’s birthright, but that it is something of a lost art, that compliance often robs people of it, that creativity depends on it, and that therapy can serve as a means of rediscovering it if a therapist is sensitive to the need and does not let their male element, in the form of intrusive interpretations, however erudite they may be, interfere. The Buddha, to my mind, thought along the same lines. He said that our original nature is obscured by our cravings and our frustrations, that the ego that emerges in healthy emotional development, while necessary for some things, also blocks us from our underlying and inherent freedom. “Be here now,” my old friend Ram Dass used to proclaim, making it sound as if it were the easiest thing in the world.

As is evident in my write-ups, I do not model this sensibility by resting calmly in a meditative state while my patients free-associate. I engage actively. But I am very quiet inside when I am working; all of my concentration, all of my attention, goes to the person I am with. And I want to know everything, from the television shows they are watching to the food they are eating to their most dreadful thoughts and reflections. I believe in the power of awareness to heal. I want my patients to see how and when and where their egos, or superegos, are getting the

best of them, because I know that if and when they can see this clearly, something in them will release. And their best chance of seeing it comes when my mind is quiet. Somehow, my inner silence resonates in them and feeds their awareness. Each person is like a koan I cannot solve with my rational mind.

He [Winnicott] was by no means a Buddhist, but I believe he, too, healed by modeling being. He mostly used mother/infant vocabulary to describe his mode of relating, but this did not stop him from describing, in disarmingly frank terms, his own internal process:

It is only in recent years that I have become able to wait and

wait . . . and to avoid breaking up this natural process by making

interpretations. . . . It appals me to think how much deep change I

have prevented or delayed . . . by my personal need to interpret. If

only we can wait, the patient arrives at understanding creatively

and with immense joy, and I now enjoy this joy more than I used to

enjoy the sense of having been clever. I think I interpret mainly to let

the patient know the limits of my understanding. The principle is

that it is the patient and only the patient who has the answers. We

may or may not enable him or her to encompass what is known or

become aware of it with acceptance.

Learning by unlearning. How often in this book have I disoriented people to the systems and explanations they have created for themselves? Disorienting systems is something both Buddhism and therapy can agree on. Things that feel fixed, set, permanent, and unchanging, like one’s self-righteous anger, are never as real as they seem. Problems are not hard and

fast, selves are not static and motionless, even memory is nothing we can be certain about. The Zen of therapy wants to get things moving again. It wants to open things up, make people less sure of themselves, and in the process release some of the energy that has become stuck in the mud. Rational explanations have their place, but irrational breakthroughs, like

those that come out of koan practice, are invigorating because they alert us to capacities we do not know we have.

The path I have outlined eventually leads to the realization that simple kindness is the fuel of the peace of mind we all crave.

The main theme of Buddhism,” the Dalai Lama began, “is altruism based on compassion and love.” He then went on to teach the foundational Tibetan Buddhist practice of “mother recognition”: imagining all beings as one’s mother.

Again, in order to have a sense of closeness and dearness for others,

you must first train in a sense of their kindness through using as a

model a person in this lifetime who was very kind to yourself and

then extending this sense of gratitude to all beings. Since, in

general, in this life your mother was the closest and offered the most

help, the process of meditation begins with recognizing all other

sentient beings as like your mother.

I remember talking with another Tibetan lama, years later, about how difficult it is for some Westerners to engage with this idea because of how conflicted they are about their own

mothers. “For those people,” the lama said, smiling, “I always say think about your grandmother instead.” He would have approved of my new friend Zeki’s ayahuasca memories!

Our minds are like children, and mindfulness, like a good therapist or a good-enough parent, “holds” them so that they can grow up and come to their senses. With enough practice, and enough patience, breakthroughs occur. These take many idiosyncratic forms but they are

generally of two types.

On the one hand, there is a loosening of identification with the known self; people see their self-concepts as just concepts that have arisen and accumulated in response to the particular challenges and conditions of their lives but that have no ultimate stigmatizing reality. On the other hand, there is a return to simply “being.” This is set in motion when awareness becomes dominant, when the observing mind becomes stronger than that which is being observed. As this observational capacity develops, a change sometimes occurs. Instead of one part of the mind observing another—“me” watching “myself”—the whole thing collapses and just “is.

Mindfulness, if it resurrects anything, resurrects the holding environment of the good-enough parent so that our own still-primitive minds can grow out of their tendency to cling to their own misperceptions. In setting this up, mindfulness, like therapy, helps us make peace with our personal histories while encouraging us not to be overly defined by them. Holding this dual reality is what allows being to shine through. One does not experience this as a state of merger (in which one person or one thing dissolves into another) but rather as a state of clarity, as if the conceptual barriers of who we think we are have been lifted from the mind.

We are full of preconceptions about ourselves and are limited by them. The actuality of our being is not something we have an easy time making room for.

This is mother recognition from the other side. Not only have all beings been our mothers but we are also mothers to all beings: the womb of compassion is there within us waiting to be rediscovered. When we realize how readily we have misconstrued ourselves, when we stop clinging to our falsely conceived constructs of how limited, isolated, and alone we are, when we touch the ground of being, we come home.

The psychoanalyst Michael Eigen, in his endlessly inspiring book The Psychoanalytic Mystic, came at this mysterious undercurrent from another direction. Rather than leading with anything like loving awareness, he focused on the underworld.

As a patient of mine once quipped when speaking of how writing her memoir had helped her

deal with a sudden and unimaginable tragedy that had upended her life, “Writing is a much better quality of agony than trying to forget.

We cannot erase our histories no matter how hard we try, but in learning to face them with kindness, as so many of my patients have been able to do, we enter the stream that flows gently, if not always merrily, toward inner peace.